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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1pYEAR FROM DATE ISSUED <br /> JOB ADDRESS 35c�� W• E1.E�f:N't'tii' ST' CITY/ZIP TR,Pccy /S�O`� <br /> _ �1 <br /> CROSS STREET KIKSD� APN 2-3'1 -1 0(W0- H 6ry PARCEL SIZE p <br /> OWNERNAME JASDEEP S1NGy+ `<&UfL PHONE ko40 _)4-0-0 yd <br /> tMi, <br /> OWNER ADDRESS 7-5'44C) <br /> 5'4TC s• 5CtLTF- 02-b.- CITY/STATE/ZIP 'rg-A-r-y CA 9 <br /> CONTRACTOR LNVE DP4K- VFr OENVI R-ONyN Gv rteL- PHONE % 1 - 03--w <br /> '95,�^ <br /> CONTRACTOR ADDRESS �� W • O A-K ST' CITY/STATE/ZIP ( C. -f 5 <br /> LICENSE I IC-42 LC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y �T <br /> PERC TEST # F BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 1 1 REPAWADDITION F1 ENGINEER DESIGNED/ALTER ATIVE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL _ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> I IMUU/'�3�HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 /, <br /> SIGNED /��( TITLE CA145y Thn•T DATE I I-Z�'I6 <br /> H.F PMNNG t <br /> J�\ - ��4fM1 113-2]0-11 <br /> u3eERr R.Ews <br /> 12'N 75'IAIICK NORTN IN 230-050-22 <br /> 1I�WNelER <br /> 213-27 12 / -1.R ANO PPRiN <br /> 1 ITYP.) —w OfsO TR. <br /> WAK E.TRICO iA_ 39 050 2 <br /> 5 - � 2RAMN4R <br /> \ 17%JO'TRUCN 213-2)0-13 <br /> M AC <br /> \ PMN-HG(TYP.) EPOS >- <br /> \ <br /> \ � ` SITE LOCATION .6 t <br /> i <br /> —­D-07 <br /> UNKK—CE C-.7�q —M mv.> i rac ux N'�'ION .z3s-oeG-oT <br /> `rS°N \ we.sucEACE pYP.> vT-GSG-GS scum NrssaN uc <br /> � mENERG uN <br /> SUiU,L P.) VICINITY MAP <br /> NEW ORNEWAr \ <br /> \s <br /> EPARTMftu <br /> Application Accepted ateArea Employee ID#Final Inspection By DateSPE AL PERMIT-Approved byCharacter of Soil to h of 3 Ft: Character: �A <br /> COMMENTS T(i a ����,Nl,��N, Y�r'�"C® <br /> i <br /> RECEIVED <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# 2 v 20% <br /> Code INFO B Cash Remitted Service Reuest# <br /> L 5 AQUIN COUNTY <br /> ENIN <br /> IRONMENTAL <br /> HEALTH DEPARTMENT <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />